Abstract

Introduction To determine the nature and assess the current clinical pathways for the ultrasound-detected gallbladder polyps (GBP) and propose a follow-up and a therapeutic strategy based on size and symptomatology.

Methods A retrospective search of the US database for “polyp” in gallbladder for the period between 1st January 2009 and 31st December 2010 was conducted. A database was then constructed including demographics, clinical presentation, principal symptoms, management and pathology. Histologic findings were analysed in patients who underwent cholecystectomy. The electronic medical records were searched to check the clinical outcome, pathologic data and follow-up arrangements.

Results Ultrasound detected gallbladder polyps were reported in 347 patients, 214 female and 133 males with an age range between 14 and 93 yrs, (Median 5, IQR=41–58). Polyps were found during the course of investigation for the possibility of gallbladder disease in 125 patients (36%). The rest were incidental finding during investigation of other illnesses. The majority of referrals for the US came from primary care (60%), the rest came from hospital physicians in (24%) and surgeons in (13%) of cases. Forty two percent of the reports made no mention of polyp actual size and 39% reported the polypoid lesion to be

Conclusion Our preliminary data confirm that the majority of the US detected “polypoid lesions” are incidental findings and are not true epithelial polyps. The majority of patients with symptomatic polyps who underwent cholecystectomy had cholelithiasis on histology. The current management strategy of asymptomatic polyps relies on its size and hence must be included in the US report which was poorly complied with in this series. Small (10 mm should be offered cholecystectomy. A well defined long term follow-up of patients is necessary to allow better understanding of this pathological entity and a nationwide registry or large longitudinal observational study is warranted as these might represent a missed opportunity for early detection of cancer.

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